

 <div class="col-md-8 col-sm-8 col-xs-8">
  <div id="register" class="modal fade">
    <div class="modal-dialog max-width-350">


        <div class="modal-content">
          <div class="modal-header">
            <button type="button" class="close" data-dismiss="modal" aria-hidden="true">&times;</button>
            <h3 class="modal-title">Complete your registration</h3>
          </div>
          <div class="modal-body">
            <div class="upper-contain">
              <div class="wrap-reg-text">
                <p>We use this to check your age and location.<br> It won't be shared with other.</p>
              </div>
              <div class="wrap-reg-lock">
                <span class="glyphicon glyphicon-lock lock"></span>
              </div>
            </div>
          <form id="form" class="form-horizontal" role="form">
            <div class="row">

              <div class="col-md-6">
                <div class="form-group form-reg-marg">
                  <label class="h3">Name</label>
                  <input type="text" class="form-control" placeholder="First Name">
                </div>
              </div>

              <div class="col-md-6">
                <div class="form-group align-inputs-last form-reg-marg">
                  <input type="text" class="form-control " placeholder="Last Name">
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-md-4">
                <div class="form-group form-reg-marg">
                  <label class="h3">Birth</label>
                   <select id="id_select" class="selectpicker form-control" multiple>
                    <option>Day</option>
                    <?php
                        for($a = 1; $a<=31; $a++){
                          echo "<option>" .$a. "</option>";
                        }
                    ?>
                  </select>
                </div>
              </div>

              <div class="col-md-4">
                <div class="form-group align-inputs-last form-reg-marg">
                  <select id="id_select" class="selectpicker form-control" multiple>
                    <option>Month</option>
                    <?php
                        $array = array("January","February","March","April","May","June","July","August","September"
                                        ,"October","November","December");
                        for($a = 0; $a<=count($array)-1; $a++){
                          echo "<option>" .$array[$a]. "</option>";
                        }
                    ?>
                  </select>
                </div>
              </div>
              <div class="col-md-4">
                <div class="form-group align-inputs-last form-reg-marg">
                    <select id="id_select" class="selectpicker form-control" multiple>
                    <option>Year</option>
                    <?php
                        $array = array("1990","1991","1992","1993","1994");
                        for($a = 0; $a<=count($array)-1; $a++){
                          echo "<option>" .$array[$a]. "</option>";
                        }
                    ?>
                  </select>
                </div>
              </div>
            </div>
            <div class="row">
              <div class="col-md-8">
                <div class="form-group form-reg-marg">
                  <label class="h3">Postcode</label>
                  <input type="text" class="form-control" placeholder="Postcode">
                </div>
              </div>
            </div>
            <div class="row">
              <div class="col-md-12">
                <a href="#" class="btn btn-success pull-right">Continue</a>
              </div>
            </div>
        </form>


          </div>
        </div>


    </div>
  </div>
</div>
